Cost-Effectiveness of Anti-Retropulsion Devices for Ureteroscopic Lithotripsy

Purpose: We evaluated the cost-effectiveness of anti-retropulsion devices used during ureteroscopic lithotripsy. Materials and Methods: A decision analysis model was constructed to compare the cost-effectiveness of ureteroscopic lithotripsy with vs without an anti-retropulsion device. The risk of stone retropulsion was determined from published data in the English language literature. Expected value calculations were used to determine whether the additional cost of a device would be cost-effective to prevent secondary procedures used to treat retropulsed stones. Device cost was determined using the average cost of all commercially available devices. Results: It became cost-effective to use an anti-retropulsion device at or above a 6.3% retropulsion rate. The weighted probability of retropulsion with vs without an anti-retropulsion device was 98.1% vs 83.7%. The estimated costs of secondary procedures needed to treat retropulsed stones were $5,290 for shock wave lithotripsy and $6,390 for ureteroscopy. Average device cost was $278. Thus, the average additional cost of ureteroscopic lithotripsy with vs without an anti-migration device would be $384 vs $952. Conclusions: It is cost-effective to use an anti-retropulsion device at a retropulsion rate of greater than 6.3%.